Glycated Albumin to Glycated Hemoglobin Ratio is a Sensitive Indicator of Blood Glucose Variability in Patients with Fulminant Type 1 Diabetes

Abstract

Background Since serum albumin is glycosylated more rapidly than hemoglobin, it is possible that the glycated albumin (GA) to HbA1c ratio (GA: HbA1c ratio) is potentially a more sensitive indicator of blood glucose excursion than HbA1c. The aim of the present study was to assess the clinical usefulness of GA: HbA1c ratio as a marker of daily glucose excursions in patients with type 1 diabetes according to the subtypes; acute onset type 1A, fulminant and slowly progressive type 1 diabetes. Methods Fifty-six outpatients with type 1 diabetes [16 fulminant, 20 acute-onset type 1A and 20 slowly progressive (SPIDDM)] were recruited consecutively. Each patient performed self-monitoring of blood glucose at seven points a day. The associations among the daily profile of glucose and GA, HbA1c, GA: HbA1c ratio were examined across and within the subtypes of type 1 diabetes. Results GA and GA: HbA1c ratio were each independently correlated with mean amplitude of glucose excursion (MAGE) in patients with type 1 diabetes (F=27.53, p<0.001 and F=13.02, p<0.001, respectively). GA: HbA1c ratio was significantly higher in fulminant type 1 diabetic patients than in SPIDDM patients (3.5 ± 0.2 vs. 3.2 ± 0.5, p=0.015) and it was independently associated with MAGE within fulminant type 1 diabetes (F=21.2, p<0.001). Conclusion In conclusion, the present study demonstrated that GA: HbA1c ratio could be a better marker for glycemic variability than HbA1c in type 1 diabetes, especially in fulminant type 1 diabetes.

Evaluation of Glycemic Variability in Well-Controlled Type 2 Diabetes Mellitus

“…A recent study reported that GA may reflect not only the average glucose level, but also glucose fluctuations and postprandial glucose excursions. 32 Our findings are consistent with these results. Because GA levels increase as blood glucose levels rise 33 and the rate of GA level increase is 10 times faster than that of hemoglobin, 34 serum GA levels may also be affected by temporary blood glucose spikes.…”

A newer conversion equation for the correlation between HbA1c and glycated albumin

“…Accordingly, GA is used as an index of short-term glycemic control [2]. For example, the GA : HbA1c ratio has been suggested to be a better marker of glycemic variability than HbA1c in type 1 diabetes, especially in fulminant type 1 diabetes [3]. Importantly, a few past studies have suggested that HbA1c is closely associated with the fasting plasma glucose level, while GA is more closely associated with the postprandial plasma glucose level, compared with the HbA1c level [4][5].…”

Glycated albumin and ratio of glycated albumin to glycated hemoglobin are good indicators of diabetic nephropathy in type 2 diabetes mellitus

“…15,16 Recent research suggested that GA:HbA 1c ratio rather than GA itself has been reported to be a useful index of glucose excursion and is related to beta cell function. 22,24 These findings suggest that GA:HbA 1c ratio measurements may be helpful in indicating DN in patients with diabetes. However, until now, there was little research on GA:HbA 1c ratio function for DN presence.…”

“…It has been reported that the GA:HbA 1c ratio is more closely associated with postprandial plasma glucose levels and insulin secretory function than HbA 1c . Recent research suggested that GA:HbA 1c ratio rather than GA itself has been reported to be a useful index of glucose excursion and is related to beta cell function . These findings suggest that GA:HbA 1c ratio measurements may be helpful in indicating DN in patients with diabetes.…”